Preterm Infant

Question 1

how many weeks is preterm

Answer 1

<37

Question 2

how many weeks is term

Answer 2

37-42

Question 3

how many weeks is post term

Answer 3

> 42 weeks

Question 4

what is an extremely preterm baby

Answer 4

23-27+6 weeks

Question 5

what is a very preterm baby

Answer 5

28-31+6

Question 6

what are the risk factors for preterm delivery

Answer 6

> 2 preterm deliveries

abnormally shaped uterus

multiple pregnancy

interval of <6 months between pregnancies

IVF

Smoking, drinking alcohol and using illicit drugs

poor nutrition, some chronic conditions, multiple miscarriages or abortions

Question 7

whats the main differences b between preterm and term babies

Answer 7

preterm:

need more help to stay warm

have more fragile lungs

dont breathe effectively

have fewer reserves

delay cord clamping if possible

Question 8

what are common problems of looking after premature babies

Answer 8

temperature control 
feeding/nutrition 
sepsis 
system immaturity/dysfunction
other metabolic problems

Question 9

what problems can occur due to system immaturity in the preterm infant

Answer 9

Respiratory distress syndrome
Patent ductus arteriosus
Intraventricular haemorrhage
Necrotising enterocolitis

Question 10

why do pre-term babies get hypothermia

Answer 10

thermoregulation is ineffective due to:

• low base metabolic rate
• minimal muscular activity
• subcutaneous fat insulation
• high ratio of surface area to body mass

Question 11

what two conditions are directly linked to hypothermia and can be prevented by keeping the baby warm

Answer 11

hypoglycaemia

hypoxia

Question 12

how do you maintain a baby’s temperature

Answer 12

wrap or bags
skin to skin care
transformer mattress
prewarmed incubator

Question 13

what is the first organ to mature in a preterm baby once it has been born

Answer 13

skin

gets thicker and more layers develop

Question 14

why are preterm babies at increased risk of malnutrition

Answer 14

limited nutrient reserves
gut immaturity
immature metabolic pathways
increased nutrient demands

Question 15

how do you feed a premature baby

Answer 15

mum needs to express to that it can be given to the baby in a tiny bottle before it is mature enough to be able to breast feed

donor breast milk can also be used for preterm babies if mum cant produce yet

Question 16

cause of early onset neonatal sepsis

Answer 16

due to bacteria acquired before and during birth

Group B strep
Gram -ves

Question 17

cause of late onset neonatal sepsis

Answer 17

acquired after delivery

(hospital associated infection, community sources)

coagulase -ve staph
gram -ves
staph aureus

Question 18

how does prematurity increase risk of sepsis

Answer 18

immature immune system
intensive care environment
indwelling tubes and lines

Question 19

how do you manage infection in preterm babies

Answer 19

prevention 
hand washing 
super vigilant infection screening 
judicious use of antibiotics 
supportive measures

Question 20

what respiratory problems to premature babies get

Answer 20

Respiratory distress syndrome
Apnoea of prematurity
Bronchopulmonary dysplasia

Question 21

what is respiratory distress syndrome

Answer 21

surfactant deficiency and structural immaturity in preterm babies

alveolar damage occurs - formation of exudate from leaky capillaries and inflammation occurs

common - 75% of infants born before 29 weeks

Question 22

what are the clinical features of respiratory distress syndrome

Answer 22

respiratory distress 
tachypnoea 
grunting 
intercostal recessions 
nasal flaring 
cyanosis 

worsens over minutes to hours

gets worse till days 2-4 then gradual improvement

Question 23

how to you manage respiratory distress syndrome

Answer 23

maternal steroids
synthetic surfactant
ventilation
(invasive/non invasive)

Question 24

what is patent ductus arterioles

Answer 24

when the ductus arteriosus hasn’t closed yet - as it isn’t meant to close until after birth

duct in between aorta and pulmonary artery

Question 25

what is intraventricular haemorrhage

Answer 25

blood in the ventricles of the baby

Question 26

how do you classify intraventricular haemorrhage

Answer 26

grade 1-2: neurodevelopment delay up to 20%, mortality 10%

grade 3-4: nuerodevelopmental delay up to 80%, mortality 50%

Question 27

what is necrotising enterocolitis

Answer 27

gut is not ready for motility - gets damaged when trying to have milk

gut bacteria translocated from the gut across the broken barrier of the gut and gets into the blood system and leads to sepsis

seen in extreme preterm babies

Question 28

what are some other complications of prematurity

Answer 28

retinopathy of prematurity
(usually 6-8 weeks after delivery)

matabolic
early - hypoglycaemia/hyponatruamia

late- osteopenia of prematurity